NYC 9/11 Public Portal Document
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1. Client: 2. Project Name: 3. Project Address: 4. Project # 5. ate:
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PREP-INSPECTION CHECKLIST:
Work Area Location:
Pass Fail NLA Pass Fail N/A
1. Vacated by occupants. 8. Openings <32f1' covered by 2 lyrs poly.
2. Warning Signs (Eng, Sp). 9. Openings >32ft2 covered by plywood
and two layers of poly.
3. Electricity down/locked out.
10. Movable objects pre-cleaned. removed
4. Power outside work with GFI. from area.
5. HVAC off, locked-out, isolated, 11. Fixed objects pre-cleaned, plasticized.
or pressurized.
6. DECONTAMINATION UNIT: 12. Floor poly 611 onto walls (121'=NYS).
* Outside work area 13. Wall poly to the floor.
• Cln, shwr, egpt rooms 14. 6" overlap between adjacent sheets
of poly.
• 2 layers, 6-mil wall poly
15. Elevator bypasses work area.
• 2 layers, 6-mil floor poly
16. Plywood/poly barrier before elevator
• 1 shower per 6 workers doors.
• Hotcold water 17. Perimeter diaphragm for elevator
barrier.
• Waste water < 5 microns
18. 4 air changes per hour from negative
• Waste water sewer/drum air unit.
• Soap/Shampoo 19. New filters in negative air units.
• Disposable towels 20. Negative air pressure > 0.02
• Waste bags 21. Minimum 2 means of exiting work area.
7. POSTINGS: 22. Toilet for abatement personnel.
• Regulations 23. Waste Decon for > 1,000 ft. ACM
(NYC, NYS, OSHA, EPA)
24. The following additional equipment:
• Sign-in logs
• 6-mil disposable bags with
• Evacuation Plan warning labels
• Supervisor's license • Poly and Duct Tape
• Worker licenses • Fire extinguisher
• ACP-7 • Approved respirator
• Building Permit/Placard • Replacement filters
• EPA 10-day notification • Protective Clothing
• NYS Notification 25. Work area pre-cleaned
• Emergency Numbers 26. Work area passes inspection Yes _ No
• Material Data Sheets
PRE-ENCAPSULATION/FIN' PECTION CHECKLIST:
1
Work Area Location: /~ v 1 1_
Pass Fail NLA Pass Fail NL
1. No visible debris on walls, floors. 8. No bags of waste in work area.
2. No visible debris between decking 9. All equipment clean.
and beams.
10. Neg. Air > 0.02 inch. of water.
3. No visible debris behind perimeter
columns. 11. Airless spray equipment used.
4. No visible debris on top of ducts. 12. Work area is dry, free of water pools.
5. No visible debris on hangers, rods, 13. The area suitable for encapsulation.
lights. 14. The area suitable for final air clearance.
6. No visible debris on poly.
15. Work area passes inspection. - Yes _ No (Explain why)
7. No visible debris on pipes.
Form NY-9 1/01
NYC-WTC 000108827
OCR can misread numbers and units. Confirm readings against the page image before using them.